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  • Writer's pictureNick Serro


Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. This month I will face one of– possibly my largest– personal barriers in the concept of rejection sensitivity dysphoria and what exactly that means.


"But my silent fears have gripped me
Long before I reach the phone
Long before my tongue has tripped me
Must I always be alone?"
- Sting, bassist/vocalist of The Police

Let's get it out of the way immediately– who does not feel sensitivity around rejection??

“Rejection sensitivity dysphoria” is a term which broadly refers to an overactive and dysregulated emotional response to the feeling of rejection. The term refers not to a medical condition, but rather describes a person’s emotional experience. While this could seem slightly subjective, the differentiation between typical human body reactions and more extreme ones can be seen in defining many conditions. For example:

Everyone can be forgetful, but distinctly ADHD individuals suffer great anxiety and shame around forgetting things. Fear is how we would describe the emotions present when being chased by a tiger, but having the same feeling every morning when we wake up (assuming we are not waking up to a tiger, of course) is considered anxiety for lack of adequate stimulus. We would expect very down emotions in a time of grief; it is depressive emotions in times of expected joy which indicate depression as a condition.

This month we will explore further into what this term really means, and how we can actually define it.


In this case we are talking about an extreme reaction to rejection, whether acutely in the form of an emotional outburst or meltdown or more abstractly via the negative impact that one situation of rejection permeates into overall wellbeing and disruption of quality of life. Perhaps the largest actual influence of rejection sensitivity is the proceeding feelings of avoidance and hesitation which can eventually govern most facets of decision making, whether rejection is present or not. While a firm, tangible threshold for the condition may never fully solidify, we can also just focus on the extremity of different negative impact outcomes that rejection-related issues may cause for each individual.

While most people certainly wouldn’t go back to a restaurant if staff was explicitly verbally abusive towards them and told them they were not welcome during a dining experience, someone with rejection sensitivity might feel the exact same way off of a perceived rejection, such as a waiter taking longer to get to their table than others. Further, in the former example, someone with RSD will likely struggle to not self-blame even if the other party is clearly the aggressor at fault.

Much like similar internalized perception symptoms, awareness of rational logic does not help in these situations, which is where we get the descriptor of ‘dysphoria’. To clarify, this does not necessarily mean the person is misperceiving the situation as a “slight” or feeling attacked, it is pure negative emotional pain in response to the perception of getting rejected. Rejection sensitivity can present as a hidden, internal symptom, but can also present outwardly if pain is too hard to bear. Even if the individual is able to rationalize that they are having an overdrawn reaction, the actual feelings do not necessarily subside, and a lingering sense of negative emotion will still remain present, all obviously very disruptive towards functioning.

The second interpretation is less clear– well, not particularly to myself as someone who experiences it– but still very present, and that is how over time, RSD can lead to major problems with initiation, assertation, confidence, conflict resolution, and avoidance. Just to name a few. When THIS manifestation presents, we see much more ‘blanketing’ repercussions occur from a lifelong series of sensitivities around rejection, and our actual behaviors and decision making can be impacted. If someone with RSD had an experience in childhood with a coach who was very dismissive and harsh when criticizing the individual, that person might avoid not just ever trying a sport again, but also become hesitant and sheepish around any person who appears to be in a coaching type role. Continuously being told that we are doing something “wrong” without proper constructive criticism– or even with it, in some cases– becomes a major deterrent to trying new things which may develop as a defensive mechanism such as apathy or cynicism. Similarly, the response quickly becomes about all trauma and pain that the individual is experiencing beyond just the isolated acute rejection, and has an “opening of the floodgates” type of effect. This may be more accurately labeled as a PTSD response, but with the specific trigger being rejection.

A MAJOR note to keep in mind with RSD as well is that it is not as simple as wanting to avoid pain, but rather more about avoiding the disruptive and dysregulating nature of rejection sensitivity. While acute pain is sharp and then leaves, one rejection may lead to a negative emotional spiral of hours to days or even weeks within the individual, and unfortunately has the power to derail even an otherwise very enjoyable day for RSD individuals. This additionally can be used to differentiate a normal rejection response from RSD– re-regulation from rejection is a significantly slower process. The idea of avoiding rejection is not just about not wanting to face immediate pain, but rather an act of foresight around future regulation.


While comorbidity can become a splitting hairs situation, it is also important to differentiate the condition from those with larger emotional dysregulation profiles such as depression or bipolar disorder. Put another way, the reaction to RSD proper will be distinct to rejection-based emotions and be constantly present throughout an individual's lifespan. If I dysregulate after perceiving being let go from a job as rejection, that is more intense than dysregulation around feeling angry about a coworker being annoying or working conditions becoming unfair to employees, and would happen to some degree any time I got let go regardless of circumstances.

Here are further examples of comorbidity:


Well, both anecdotally and according to a study, upwards of 99% of individuals with ADHD have comorbid RSD. I have zero rebuttal to this statement, as I have arguably yet to work with a single ADHD individual who did not face at least some intensified adversity with rejection specifically. The psychology is actually rather simple: a defining feature of most childhoods of ADHD individuals is an endless and constant stream of redirection: ranging from “don’t do it that way, that’s not the right way, just do it the normal way”, and similar all the way to “you are so stupid, everyone in the world gets this except you, why can’t you just be normal”.

Those effects are assuredly felt in later life.

The result leads to development into the aforementioned ‘abstract’ RSD: we anticipate rejection constantly, and make decisions based on vigilantly avoiding any situation which risks rejection. The sensation of rejection sensitivity is a little hard to describe, but from my own account and many, many other empirical studies, over 1 in 3 people say it’s the most difficult part of ADHD. I would personally describe it as a constant anxiety that is similar to the feeling of when we have done something wrong or are forgetting something, and in turn makes asking a rejection-vulnerable question truly more threatening than the rejection itself. Illogical and/or frustrating as this may be to read, it is genuinely a hard question to ask whether I would rather risk the aftermath of rejection over never attempting at all.

A final, VERY IMPORTANT NOTE: rejection sensitivity is sometimes misperceived or imagined, perhaps more so in adulthood, but studies have also concluded that ADHD children will have received 20,000 more negative messages about themselves by age 12 as compared to the general population. An important thing to keep in mind when asking “but why can’t we just look past ourselves and see that we can do it!”


Autism follows similar RSD development patterns to ADHD, particularly in cases of high-functioning or undiagnosed individuals who are holding themselves to more neurotypical standards and expectations. The archaic diagnosis of “twice exceptional”, the description of which is most simply boiled down to ‘extreme intelligence to the point of disconnect with peers’, is likely just a blanket term given to high functioning cases of both autism and ADHD that creates intense amounts of burden via expectation as well as overlooks social deficits that may be unaddressed. As may be more clear now, the recipe is centered around a misperception of abilities and expectations, something that has created many barriers around ASD in general.

One caveat to this situation may also be that misperception of social rules can also prevent RSD. For individuals who have more challenges reading or understanding social cues, we see a true ‘ignorance is bliss’ scenario in the fact that we cannot feel the pain of being rejected when we do not fully grasp the concept in the first place. This may be true universally, but more likely to be true in certain facets but not others.


One way to look at the relationship between RSD and BPD is to focus on the nuance and extremity, as each condition is vulnerable to being misdiagnosed as the other likely due to these features. While a person suffering BPD symptoms is very likely having oversensitivity around rejection, this disorder is much more encapsulating rather than rejection-specific. Someone who is experiencing extreme reactions in general may relate to RSD entirely, but must be treated on a larger and more holistic scale if similar intensities are seen in other realms.

In the reverse, someone having extreme reactions to rejection may be seen at such dysregulatory heights that they may be misdiagnosed with BPD due to similar presentation. This is rather unsurprising considering the similarities between abandonment and rejection reactions as well as a distinct manifestation of a very intense reaction towards a perceived ‘ordinary’ situation. This is arguably further detrimental towards an individual, however, as RSD treatment will still be somewhat effective for BPD whereas BPD treatment for RSD may create a lot more confusion and trouble for the person understanding how to manage their symptoms. Again, while situations can be tricky to decipher accurately, the isolation of solely rejection reactions being dysphoric is the most important distinction.


All in all, you could argue that RSD is most broadly formed when a person is not accurately aware of their abilities and limitations and responds by taking an overcorrective ‘guess’ that creates a false and damaging expectation. The key mechanism for the dysphoria then must be derived from a misperception of the most typical understanding of rejection, and this effectively has to derive from either or a combination of reduced understanding of social norms along with negative experiences around rejection specifically. While RSD can form alongside anxiety-based conditions and others, there is not much suggesting that it could develop as a fully isolated phenomenon.


There are undoubtedly many points in anyone’s life where they must face a rejection of sorts, but how impactful that incident is will vary greatly based on a variety of predisposed factors. Some people may take some rejections more or less intensely than they expected, and the amount of humans which are unaffected by negative responses in these situations are slim. The “sting” of rejection is well documented, even for those who we see as unaffected, and the confusion around the condition is well justified. But at the end of the day, “you will miss 100% of the shots that you don’t take”, right?

This famous quote from hockey legend Wayne Gretzky might serve as a good measure to differentiate the dysphoria from a typical reaction: surely, myself or anyone else with RSD understands this logically. To use the example itself, what is being overlooked is that you will indeed never make a shot if there is never an attempt… but may feel much greater pain over the ones that we miss rather than success from shots made. This analogy quite simply does not apply to certain individuals, and you can ask a list of infamous sports scapegoats such as Bill Buckner or Matt Ryan who each committed a single blunder that lost their teams a championship that, despite having illustrious and successful athletic accomplishment that will trump 99.99% of the rest of the population’s accomplishments in that realm, overshadows their entire career as far as public perception. While it is easy to look from a third person perspective and say “we should just appreciate what we did do”, that is not necessarily going to be an easy mindset to sustain nor what outside sources are going to repeatedly reinforce. While I am certainly proud of all my successes, I have to also candidly report I am equally or more scarred and deterred by rejections, and even as a therapist who has worked with this for nearly a decade, those negatives very unfortunately take precedence over the positives at almost all times. An empirical study found that heightened sensitivity to rejection reactions created significant difficulties with attention, goal setting, and initiation-- so perhaps the focus of the damage should not necessarily be around rejection specifically, but rather the ramifications.

Typically, this massive emotional burden will then present as one of two extremes: people pleasing or quitting. In the former, actual desires and needs are foregone for the fear that we will upset someone, ultimately making a ‘chameleon’ type situation in which the person may present as very intuitive and charismatic, but feels disingenuous that they are hiding their true opinions as a result. We are now living a life with this feeling which favors making safe, undesired decisions over desired ones. In the latter, the pain of perceived impending rejection feels too great to even attempt, and we see situations where the individual may be stuck in ‘emotional inertia’ due to paralyzing fear of perceived rejection. This usually develops labels such as “lazy”, “unmotivated” or “not trying”, truly a cruel irony for a response which was avoiding rejection in the first place. Regardless of reaction, the burden creates great exhaustion which peripherally creates worse executive functioning and clarity in all facets of life for those with RSD. It is not too hard to see where a vicious cycle can keep individuals in this loop for life.


Please do NOT try these at home. I will never claim that any strategy is completely useless to all individuals, but here are some strategies that I have seen attempted for a 0% success rate in my clients’ as well as my own experiences.


Obviously covered earlier, but this risks creating further intersectionality in overlooking an individual who is indeed experiencing dysphoria around rejection. This quote, at least in my experience, is socially viewed to be objectively correct, which creates a message that is similar to “it is how it is” or “that’s just life” instead of “most people feel this way, but some people actually really struggle to relate to this comment”. A better approach for someone who may suspect that they have RSD would be to critically analyze whether the reward of success is actually being perceived as a larger motivator than the avoidance of pain from rejection/failure (from a non-judgmental perspective, of course). This alone would strongly suggest that a person may experience RSD.


Look: it will work… but at what cost? Much like any negative reinforcement style– aka punishment as response for doing something undesired– using rejection to motivate runs into multiple issues with sustainability. If the idea is to avoid rejection by appeasing all, you end up tangled into the people pleasing issue. If the idea is to be motivated by feelings of rejection, we risk isolation from others and, to be honest, this is simply not how the feelings of rejection work. Understanding rejection sensitivity as something to manage and prepare for rather than an alternative form of adrenaline may be more successful in the long run, and ultimately it is much easier to do excitation transfer strategies with external (ie: channel anger through exercise) emotions whereas rejection is a very internal emotion. In my own and countless others’ reported experiences, this is most effective in creating more guilt and shame to further weigh on us emotionally, ironically moving away from relief rather than towards ot.


Now of course therapy will help with perception and understanding, but more specifically, unfortunately no therapy can immediately ‘fix’ or ‘eliminate’ this issue. Much like intrusive thoughts, panic attacks, or similar quick, random onset mental symptoms, RSD can only be better understood and reframed from the individual’s perspective when this is happening, which is often not in a therapeutic setting. It may be difficult and/or repressed to recall the experience outside of being presently in the emotion, and unless a person is in the midst of an RSD episode during therapy, difficult to adequately assess. Though potentially unsatisfactory, therapy can still help more abstractly: my symptoms indeed still feel just as strong as before I was aware what was happening to me, but understanding, validation, and connection with many others that experience similar issues has made the condition much less overwhelming and scary.


Possibly the worst option here, as RSD appears by all accounts to be lifelong and, as would be expected given there is such great pain in rejection, creates greater pain when your feelings of rejection are rejected. The concepts of being overly sensitive, afraid of rejection, and unassertiveness are largely stigmatized in most cultures, and this only reiterates a reason for a rejection sensitive person to close themselves off in one way or another. While an easily identified presentation of this reaction may be seen as the “overactive ball of anxiety” trope, other common but less obvious manifestations may be seen in tropes such as the “bitter/angry old man”, “class clown” or “standoffish and unfriendly” archetypes via displacement or repressive reactions; not all show their sensitivity overtly, and in some cases, it is the single part of an individual that they are guarding most vigilantly.


By a pessimistic lens, it’s a grim outlook: rejection sensitivity dysphoria, as far as we understand, is one of the more undesirable, unchangeable and permanent symptoms seen within mental health, particularly as there is truly no silver lining to being susceptible to being hit with painful feelings of rejection at any random moment. But from an optimistic outlook, there is still value and improvement in awareness and acceptance.


Like many symptoms, the answer to “how do I make it stop” is a rather disheartening “it won’t”; that being said, I like to give the comparison that while it is always terrifying to see a bear, it is much scarier to see a bear somewhere you don’t expect it in a vulnerable position than seeing one deep in the forest with proper preparation. Understanding, and far more difficult accepting that we know that our reactions and symptoms are very normal to us and others with similar brain functioning can be relieving to a degree, but slowly beginning to incorporate this acceptance into how we live life despite feeling very uncomfortable to break RSD molds can be a sustainable coping strategy.


The only way that has shown to acutely stop rejection sensitivity feelings are through medications which help with brain communication and regulation centers. Anything that is prescribed for ADHD– clonidine, guanfacine, stimulants, and MAOIs– is also used in rejection sensitivity, as the same areas of the brain are being activated. While medication is typically used acutely and may act primarily as a short term option, there is also great benefit in the ease or relief that some can feel just knowing that there is a solution in worst-case scenarios. Again, recorrecting our brains to see any sort of rejection as bearable can be beneficial.


Here is an interesting angle that is going to be a little more personally based than empirical: despite a drastic overreaction to rejection, there are also times of blatant rejection in which I feel positive reactions.

I’ll use a personal example which is specific to me (as a person who does not experience social anxiety in this form) but can be generalized to most: if I am not allowed in an establishment because I am not wearing proper attire deemed arbitrarily “required” for entry (ie: not being able to enter a bar because I am not wearing a collared shirt), I actually feel relief in the fact that I am being denied entry for such bureaucratic and impersonal reasons. I have multiple hypotheses for why this may occur, but one distinction is that I have to know the rules in order to feel this way. If this same situation happened and I was not aware, I would eventually reach the same conclusion but would likely feel RSD in the process.

This suggests that some of this reaction is based in the old in-group, out-group dilemma– I feel more accepted when I refute groups I do not identify with for the same reason we root against the team that is facing our home franchise. Another theory would be that I am therefore looking at a situation more existentially– since rejection sensitivity is rooted in my own experiences and schema derived from social rules, I can most clearly compartmentalize and separate a situation like this as impersonal and based on blind construct rather than feel that I am personally flawed or incorrect.

If we look along the lines of the concept of ‘exposure therapy’, this could be seen as a way to experience rejection in a more positive light in hopes that we become more comfortable with the feeling. Ultimately, however, it’s crucial to remember this is simply a reframe tool that will help us cope and not a way to redirect our actual emotions.


You know I don’t like using the word mindfulness, but it’s just simply the best way to describe this approach. Much like many DBT-based strategies, the idea of recognizing our rejection sensitivity as it is happening will not ease any of the instant pain felt, but may work wonders to shorten the feeling drastically. The understanding of rejection sensitivity in relation to triggers as well as duration and intensity can make what is normally perceived as a terrifying and out-of-control experience into something much more expected and benign, even if the experience remains an uncomfortable one. Much like treatment for panic attacks or intrusive thoughts, the idea of becoming peacefully cohabitating with our negative and uncontrollable emotions can provide much more relief than it may appear to have at face value.


Perhaps part of the ambivalence around rejection sensitivity is the sensitivity piece: my mother was able to highlight I was more sensitive than others at a very young age, it took me until about 26 to accept that because, well, I’m sensitive! Even in discussion with clients, there is a sense of exposure and danger in looking at sensitivity as an unfixable character trait, and often alternative language finds to be more effective.

Fear of being perceived as overly sensitive is not entirely constructed— there are surely deep primal instincts that deter us from appearing vulnerable or exposed— but in a modern world, it may be the fear itself which prevents treatment. Regardless of which end of the spectrum an individual may fall on– whether that be extremely overt sensitivity or completely displaced sensitivity coming out in a very different emotion– it is clear that oversensitive perceptions are more influential on the quality of life of individuals than we may have realized.

Whether you relate to these feelings or not, I believe that the most important takeaway from rejection sensitivity is to keep in mind that it is a likely culprit in many cases of non-action that we tend to view very judgmentally or with heavy values-based perceptions. Keeping in mind the immense internal pain that can be present in cases of rejection sensitivity dysphoria may be beneficial in understanding that someone appearing sheepish, shy, apathetic, bitter, or standoffish could very well just be worried about being rejected themselves.



Next month we will go deeper into the mind-body connection and what we do– and don’t!-- understand about how keeping our bodies healthy can also benefit our mental health.



At Connected Roots, our three core pillars are connection, grounding, and confidence.

We share dedication to creating nonjudgmental and safe spaces where clients can

express themselves authentically and reach their goals.

For more information on Connected Roots or Nick Serro, please visit our website or contact us at 720-593-1062.


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